NO LINKS ARE FOUND IN BOYS' CANCERS

ANN WLAZELEK, The Morning CallTHE MORNING CALL

Cancer specialists at Children's Hospital of Philadelphia say the three Allentown cases of Burkitt's lymphoma diagnosed there in the past 1 1/2 years may not be identical and may or may not have the same cause.

In addition, they found no significant link to date between Jacob Cross, 6, and Chad Koch, 3, who died, and Steven Geiger, 10, and they doubted that regional cancer statistics would point to the environment.

Pediatric oncologist Dr. Jean Belasco said one of the three city boys she diagnosed as having Burkitt's lymphoma may have a related form of the rare childhood cancer, but not Burkitt's.

"One of the three probably does not have Burkitt's but a B-cell lymphoma, which is related," she said.

"B-cell lymphomas and Burkitt's may not all be the same . . . They behave the same. Their course and response to therapy are the same, but they may not be caused by the same thing," she explained.

Belasco said all Burkitt's cases look the same under the microscope; however, more refined technological tests reveal differences on the cellular level.

Having tested and treated all three Allentown boys, she said the features of the childrens' diseases were not identical: Two had no previous exposure to the Epstein-Barr virus or mononucleosis. She was awaiting test results on the third.

While a comprehensive, community-based investigation launched by the Allentown Health Bureau and aided by state and national experts is searching for possible causes, including environmental factors, Belasco said so far she has no clue to the cause.

"As far as I can tell it's nothing environmental, infectious, or in that sense similar in terms of a cause. I have no clue as to what it could be," she said.

Belasco said the three Allentown cases have the "deceptive appearance of an outbreak, as opposed to a true outbreak in which the numbers really reflect a true incidence or cause."

Because Burkitt's tends to run in small clusters and not recur in the same community, the incidence "washes out," she said.

Belasco and Children's Hospital cancer researcher Dr. Anna Meadows doubted that there were more cases of childhood cancers in Allentown than other communities of its size.

Meadows, who is in charge of the regional tumor registry at Children's, was in the process of pulling statistics on childhood cancers in Lehigh County to determine if the incidence was significant.

"If our incidence of childhoodcancer in Lehigh County turns out to be three times higher during the last three years than it was for the three years previous to that, then there would be reason to look more closely at Lehigh County," she said.

She said there was no reason to report two or three cases of Burkitt's in Allentown to the city Health Bureau or state "unless there was something suspicious about an environmental agent," something the cancer statistics might indicate.

Meadows said the data comparison could take "a week or so."

She said most childhood cancers were probably caused by one or more environmental factors.

"In our experience of trying to look for causes of childhood cancer, the most likely probability, aside from radiation which we know can cause some childhood cancers, is . . . spontaneous events.

"That's what geneticists call background or environmental influences. It may not be everything. It may be individual things. It may be cosmic rays," Meadows speculated.

She said she gets upset when the general population becomes hysterical about a rare cancer with no known cause, yet makes little effort to wipe out known carcinogens, such as cigarette smoking.

"Some things we will not be able to explain . . . But, one-third of all cancers in adults are related to cigarettes. More than 100,000 deaths could be prevented if nobody smoked," Meadows said.

Belasco concurred that Burkitt's studies to date have been frustrating because they have not produced answers about its cause. But researchers, physicians and the professional staff at Children's she said were committed to "painstakingly" looking for causes, including the questioning of thousands of families with cancer.